Form 4868 - Tax Extension Form

Application for Automatic Extension of Time To File U.S. Individual Income Tax Return

Form 4868 | Department of the Treasury Internal Revenue Service (99)
Part I - Identification
1. Your Name(s)

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Your social security number
2A. Date of Birth
3. Spouse’s social security number
Part II - Individual Income Tax

(If unknown leave blank)
4. Estimate of total tax liability for 2025
5. Total 2025 payments
6. Balance due
7. Amount you’re paying
See instructions
8. Check if you're "out of the country" and a U.S. citizen or resident. See instructions.
9. Check here if you file Form 1040-NR and didn’t receive wages as an employee subject to U.S. income tax withholding.
Payment

Filing fee payable to Safeguard Financial & Insurance Group Inc.

2025 Filing Extension

$25.00 Quantity

Total

Application for Automatic Extension of Time To File U.S. Individual Income Tax Return